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Introduction A significant portion of intensive care unit (ICU) patients require a Foley catheter during their admission. Foley use has become more criticized as nationwide quality improvement processes attempt to reduce catheter associated urinary tract infections (CAUTI). Burn patients in the ICU have a higher rate of catheter utilization due to difficult fluid management, need for accurate volume measurements, and significant wound care. Males may have a condom catheter exchanged once they are stabilized. Historically, a noninvasive alternative to the Foley has not been available for females. While the female external catheter has existed for quite some time and hospital systems are increasingly encouraging their use, there is no standard of practice for when they are best utilized. Specific to the burn population, potential barriers include body habitus, perineal burns, and pain on frequent changing of the device. Our study aims to evaluate the current female external catheter use in our burn ICU in order to develop a standard protocol to increase utilization while thoughtfully delineating the contraindications. Methods A quality improvement project for guidelines on the use of a female external urinary collection device was conducted. All female patients admitted to the burn ICU during 2019 were included. Data was collected on burn TBSA, anatomic location, ICU days, ventilator days, and foley catheter days. Foley catheter days, external urinary catheter days, urinary tract infection (UTI) rates, and incidence of failure of external device were collected. Results Of the 46 total female burn patients, 31 required a foley catheter at some point during their stays. 11 patients used an external urinary collection device. Of the 11 users, one urinary device had to be removed due to skin breakdown. One other patient required replacement with a Foley catheter as a result of oliguria and the need for closer fluid management. 5 of the successful users of the external catheter were clinically obese. No patients contracted a UTI while using the external catheter. 3 UTI’s developed in women while using a Foley catheter. Patients who had altered mental status and perineal wounds were not eligible to use the external catheter. Conclusions In our practice, we found contraindications to external female catheter use to include altered mental status and perineal wounds. Obesity was not a contraindication and device usage may be most beneficial in incontinent patients. Further investigation is needed to better optimize female external urinary collection device usage within the burn ICU setting. This may help minimize CAUTI’s among female burn patients.

Introduction American Burn Association guidelines recommend that all pediatric burns be transferred to a burn center if their presenting hospital lacks the necessary personnel or equipment for their care. Our institution often treats small (< 10% TBSA) burns in pediatric patients as outpatients with a non-daily dressing. The aim of this study was to determine if small pediatric burns could be managed in an outpatient manner and risk factors for failure. Methods A retrospective chart review was conducted from July 2016 to July 2019 at a single ABA-verified burn center. All patients under the age of 18 who presented for evaluation were included. Post burn day, age, sex, TBSA, burn etiology, body area burned, burn dressing type, outpatient versus inpatient management, reason(s) for admission, and any operative intervention were collected. Results In total, 742 patients were included in our cohort (Table 1). The most common burn etiologies were scald (68%), contact (20%), and flame (5%). From initial presentation, 101 patients (14%), mean TBSA 9%, were admitted to the burn unit and 641 patients (86%), mean TBSA 3%, were treated outpatient. Of those, 613 (96%) were treated entirely outpatient and 28 (4%) were admitted at a later date. There were no significant differences in age (p=0.6) nor gender distribution between those who were successfully treated outpatient and those who failed. There was a significant difference (p < 0.001) in TBSA between the patients who were treated successfully as outpatients (3±2%) versus those who failed outpatient care (4±3%). The primary reason for admission of these patients was nutrition optimization (61%). Conclusions The vast majority of small pediatric burns can be treated as an outpatient with a non-daily dressing with good results. Over 80% of pediatric patients seen in our clinic were successfully managed in this manner. As suspected, when the burns are larger in size (>4% TBSA) there is a potential increased risk for admission especially with regards to poor PO intake, so this requires close monitoring and family education. Applicability of Research to Practice Pediatric patients with small burns can be safely managed in an outpatient setting with a non-daily dressing. Those who fail will most likely fail from poor PO intake at home.

Introduction Hypoglycemic episodes are associated with worse hospital outcomes, and their incidence varies by institution. We sought to define the prevalence of hypoglycemic episodes at our burn center and determine their association with hospital outcomes. Methods We retrospectively reviewed all consecutive adult and pediatric patients admitted to our burn center from 2015 to 2019. Patient demographics and burn characteristics were recorded. The primary outcome was mortality, and secondary outcomes were total length of stay (LOS) and intensive care unit LOS (ICU LOS). All patients experiencing hypoglycemic episodes were compared to patients who did not experience hypoglycemic episodes (controls) using two-tailed t, chi-squared, and multivariate logistic and multiple linear regression analyses. Results A total of 914 patients with acute burns were admitted during the study period. Thirty-three patients (4%) experienced hypoglycemic episodes (< 60 mg/dL). Of these, 17 patients (52%) experienced a single hypoglycemic episode, while the remainder (N=16) experienced multiple hypoglycemic episodes. There were no significant differences in age, sex, or presence of inhalation injury between hypoglycemic patients and controls. Patients that experienced a hypoglycemic episode had significantly greater TBSA involvement (23% vs. 11%, p< 0.00), higher prevalence of diabetes (48% vs. 20%, p< 0.00), higher mortality (18% vs. 7%, p=0.01), longer total LOS (39 vs. 13 days, p< 0.00), and longer ICU LOS (28 vs. 4 days, p< 0.00). A single hypoglycemic episode was associated with prolonging total LOS by 19 days (p< 0.00) and ICU LOS by 18 days (p< 0.00). Hypoglycemic episodes were not associated with higher odds of mortality (OR=0.9, 95% CI 0.3–3.0, p >0.05). There were no differences in outcomes between patients with single or multiple hypoglycemic episodes. Patients with multiple hypoglycemic episodes more frequently had a history of diabetes (81% vs. 18%, p< 0.00), and worse glucose control (HbA1c, 9% vs. 7%, p=0.04) compared to patients with single episodes. Conclusions Hypoglycemic episodes were associated with longer total and ICU LOS in our study but did not portend higher mortality. Applicability of Research to Practice Quality improvement efforts to prevent hypoglycemic episodes should focus efforts on known diabetics with high HbA1c levels.